PROGNOSTIC DETERMINANTS IN EXTRAHEPATIC BILE-DUCT CANCER

BACKGROUND/AIMS: The understanding of histopathological prognostic fac tors is critical to improving surgical outcome. This study investigate d the microscopic features of cancer of the extrahepatic bile duct in order to clarify the prognostic determinants affecting surgical outcom e. METHODOLOGY: In 90 cancers of the extrahepatic bile duct, the corre lation between several microscopic parameters and survival was investi gated. Lymphatic, venous, and perineural invasion, and the surgical ma rgin (tumor-free or tumor-positive) were examined with serial step-wis e sectioned specimens. RESULTS: Seven pT1-tumors showed no venous or p erineural invasion and no lymph node involvement and were associated w ith prolonged survival (5 year survival, 86%) compared with pT2,3 tumo rs (23%). In pT2,3 tumors, lymphatic, venous, and perineural invasion was found in 80%, 47%, and 88%, respectively, with no significant diff erences in occurrence of these parameters according to the origin of t he primary tumor. As for survival with pT2,3 tumors, lymph node involv ement (58%) and status of the surgical margin were significant paramet ers (p=.0330 and p=.0309, respectively). In addition, these latter par ameters differed significantly according to the origin of the primary tumor. CONCLUSION: In cancer of the extrahepatic bile duct, lymph node involvement and status of the surgical margin were the most important microscopic parameters affecting prognosis.